Age
Your age
Your partner's age (if you have one, and they live with you)
Children
Do you have children living with you for whom you receive child tax credit or a child addition within income support?
Are any of your children age 5 or younger?
Are any of your children registered to receive free school meals?
Do you receive disability living allowance for any child living with you?
Income
What is your annual household income before tax?
Does it cost more than 10% of your income before tax to keep your home warm?
Do you receive any of the following benefits?
Indicate 'yes' for all that apply.
Income support
Income based job seeker's allowance
Income based employment and support allowance
Work related activity component of employment and support allowance
Support component of employment and support allowance
Working tax credit
Pension credit (guarantee credit)
Pension credit (savings credit)
Housing benefit
Council tax reduction
Do you receive a 'carer's premium' on any income based benefit you receive?
Do you or your partner receive any of the following disability benefits? Indicate 'yes' for all that apply.
Disability living allowance 
Personal independence payment
Attendance allowance
Disability premium within income support or income based jobseeker's allowance
Disabled child premium income support
OR income based job seeker's allowance
OR the disability element of child tax credit 
Disabled worker element within working tax credit
Incapacity benefit (short term)
Incapacity benefit (long term)
Severe disablement allowance
Industrial injuries disablement benefit
War disablement pension
NHS charge exemption
Do you or your partner hold a MATEX or MEDEX certificate providing exemption from NHS charges?
Energy company
What is your energy supplier's name?
Eligibility
Based on your answers, are you eligible for the warm home discount?
 
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